Griva Konstadina, Neo Hui Ling Michelle, Vathsala Anantharaman
Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Imperial College & Nanyang Technological University, 18th Floor Clinical Science Building, 11 Mandalay Road, Singapore, 308232, Singapore.
Department of Psychological Medicine, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore.
Int J Clin Pharm. 2018 Oct;40(5):1234-1241. doi: 10.1007/s11096-018-0652-6. Epub 2018 Jun 6.
Background Non-adherence to immunosuppressive medications following renal transplantation is a risk factor for rejection and graft loss. Despite the dire consequences, adherence lapses, both unintentional and intentional, are common and poorly understood. Objective The present study sets to compare the rates and determinants of unintentional, intentional and overall self-reported non-adherence. Setting Outpatient clinic at the National University Centre for Organ Transplantation, Singapore. Method This was a cross-sectional survey administered to N = 152 renal transplant recipients. Main outcome measure They completed the Transplant Effects Questionnaire, Beliefs about Medications Questionnaire, Multidimensional Scale of Perceived Social Support, the Depression, Anxiety and Stress Scale, and the Medication Adherence Report Scale. Clinical and laboratory information were also assessed. Results The prevalence rates for overall, unintentional, and intentional self-reported non-adherence were 19.7, 47.4, and 15.1% respectively. Unintentional non-adherence was predicted by engagement in formal work, a primary diagnosis of autoimmune nephritis, and being a recipient of a living-donor renal transplant (i.e. stable characteristics). In contrast, intentional non-adherence was predicted by co-morbid burden and patients' evaluation of the side effects of their medications. Overall non-adherence was predicted by a deliberate decision-making process involving the weighing of the costs of using immunosuppressive drugs against their perceived benefits. Conclusion The survey highlighted the importance of making a distinction between unintentional and intentional non-adherence in renal transplant recipients, and suggested that modifiable factors may be targeted in different ways in interventions to increase adherence.
肾移植后不坚持服用免疫抑制药物是排斥反应和移植肾丢失的一个危险因素。尽管后果严重，但无意和有意的服药依从性下降情况都很常见，且人们对此了解甚少。目的：本研究旨在比较无意、有意和总体自我报告的不依从率及决定因素。地点：新加坡国立大学器官移植中心门诊。方法：对152名肾移植受者进行了一项横断面调查。主要结局指标：他们完成了移植影响问卷、药物信念问卷、多维感知社会支持量表、抑郁、焦虑和压力量表以及药物依从性报告量表。还评估了临床和实验室信息。结果：总体、无意和有意自我报告的不依从患病率分别为19.7%、47.4%和15.1%。从事正式工作、自身免疫性肾炎的初步诊断以及作为活体供肾移植受者（即稳定特征）可预测无意不依从。相比之下，共病负担和患者对药物副作用的评估可预测有意不依从。总体不依从是由一个深思熟虑的决策过程预测的，该过程涉及权衡使用免疫抑制药物的成本与其感知到的益处。结论：该调查强调了区分肾移植受者无意和有意不依从的重要性，并表明在提高依从性的干预措施中，可针对不同因素采取不同方式进行调整。
